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Frequently Asked Questions (FAQs)
Health Services > Frequently Asked Questions (FAQs)
I forgot to take my birth control pill. What should I do?
If you miss one pill, take your pill as soon as you remember. Take your regular pill at the usual time, even if it means taking 2 pills in one day. Continue taking your pills, but use another effective method of birth control (in addition to your pill) or abstain from sex for 10 days to protect yourself from pregnancy, even if you begin a new pack or have your period.
If you miss two pills, take two pills the first day and two pills the next day. Continue taking your pills, but use a second method of birth control for 10 days to protect yourself from pregnancy.
If you forget more than two pills, stop taking pills. Start a new pill pack the Sunday after you missed three or more pills, even if you are bleeding. Use a second method of birth control while you are off pills AND for 10 days on your new pill pack.
Keep in mind when you skip pills, or take pills late, hormone levels can drop and breakthrough bleeding or “spotting” may occur. Keep taking your pills as usual.
If you have unprotected sex after skipping pills and are within 120 hours after the unprotected sex, you may want to consider taking emergency contraception (ECP).
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I just had unprotected sex, what should I do?
If you are within 120 hours (5 days) after having sex without protection, you can take emergency contraception (ECP) to prevent pregnancy. Emergency contraception or the “morning after pill” is 76-99% effective. You can get ECP at most of the Planned Parenthood clinics, or use our secure, convenient EC Online service.
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Can I get pregnant if I have unprotected sex while I am on my period?
Yes, there is always a possibility of getting pregnant, no matter where you are in your menstrual cycle, if you have unprotected sex. Chances could be less likely, however, when you are on your period.
Most women, if they have a normal 28 day cycle, usually ovulate, or release an egg, 10-14 days from the first day of her period. This would be the time when a woman is most likely to get pregnant. This is not applicable if she does not have a regular cycle.
Keep in mind that sperm can live in the vagina for up to 7 days. If you have sex right after your period (day 5), and release an egg on day 10, pregnancy can still occur. If you are sexually active and want to avoid becoming pregnant, your best bet is to regularly use some sort of birth control method. If you are within 120 hours (5 days) after having sex without protection, you can also take emergency contraception (ECP) to prevent pregnancy.
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How long do I have to wait after unprotected sex, before I can take an accurate pregnancy test?
A pregnancy test would show up accurately 10-14 days after unprotected sex. If you are worried about pregnancy and are within five days of unprotected sex, emergency contraception may be an option for you. Most Planned Parenthood clinics offer pregnancy test services.
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How long can sperm live in the vagina?
Sperm can live up to 7 days inside a woman’s vagina. If you are within 120 hours (5 days) after unprotected sex emergency contraception is an option. If you are more than 10 days after unprotected sex, you may want to take a pregnancy test. These are available at most Planned Parenthood clinics.
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I take birth control pills and smoke cigarettes, what are my risks?
If you smoke more than 15 cigarettes per day, and take combined oral contraceptives, you put yourself at a higher risk for cardiovascular side effects such as stroke, heart attack, and blood clots. The risk is greater for women who are 35 years of age or older and smoke, those who have high blood pressure, diabetes, and/or high levels of blood cholesterol or fat. It is encouraged for women who take birth control pills not to smoke. If you have any other risks listed, please call the clinic nearest you to make sure that your method of birth control is right for you.
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Is there sperm in the pre-ejaculatory fluid?
Yes. It is possible for sperm to be in the pre-ejaculatory fluid. As a result, withdrawl, or “pulling out” before ejaculation is not an effective birth control method.
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I just took a positive pregnancy test, what are my options?
Your first step may be to take a confirmation test at the Planned Parenthood clinic closest to you. If your test is positive, your options would be to continue the pregnancy and start prenatal care, adoption, or abortion. Planned Parenthood offers abortion services at various clinic locations. We will also give referrals for local adoption agencies.
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What is the difference between a medication abortion and a surgical abortion?
The term medication abortion is used for an abortion that is done using medications. Early medication abortion must be done in the first nine weeks of pregnancy. An ultrasound will be done to determine how far along the pregnancy is. You will be given two drugs for a medication abortion. The first drug is Mifepristone, formerly called RU-486; you will take this drug prior to leaving the clinic. Mifepristone blocks the hormone that helps to maintain a pregnancy. The second drug is called Misoprostol, it will cause cramping and bleeding to expel the pregnancy. This drug will be given to you at the clinic and you will take it at home in 2-3 days. A majority of women will have bleeding and pass the pregnancy within 4 hours of inserting this second drug.
A surgical abortion is one in which surgical instruments are used. The safest method for the performance of an abortion in the first three months of pregnancy is a procedure called vacuum aspiration or suction curettage. This procedure ends an early pregnancy by gently suctioning the lining of the uterus and removing all of the tissues of the pregnancy. A method of abortion done between the 14th and 24th week of pregnancy is called a “D&E” (Dilation and Evacuation). The D&E is a procedure that requires 2-3 days to dilate and empty the uterus. Both services are available at various Planned Parenthood clinic locations.
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What is the difference between emergency contraception and medication abortion?
There is considerable public confusion about the difference between emergency contraception and medication abortion because of misinformation disseminated by anti-choice groups. Emergency contraception helps prevent pregnancy; medication abortion terminates pregnancy. According to general medical definitions of pregnancy that have been endorsed by many organizations including the American College of Obstetricians and Gynecologists and the United States Department of Health and Human Services, pregnancy begins when a pre-embryo completes implantation into the lining of the uterus (ACOG, 1998; DHHS, 1978; Hughes, 1972; "Make the Distinction...," 2001). Hormonal methods of contraception, including emergency contraception, prevent pregnancy by inhibiting ovulation and fertilization (ACOG, 1998). Medication abortion terminates a pregnancy without surgery. By helping women to prevent unplanned pregnancies after unprotected intercourse, emergency contraception has the great potential to decrease the rate of abortion. By helping women terminate unwanted pregnancies up to 56 days after their last menstruation, medication abortion is a safe and effective option.
| EMERGENCY CONTRACEPTION (EC) |
MEDICATION ABORTION |
| What is EC? |
What is medication abortion? |
| EC contains hormones that reduce the risk of pregnancy if started within 120 hours of unprotected intercourse. The treatment is more effective the sooner it begins. Plan B is currently the only product marketed specifically as emergency contraception. Certain oral contraceptives taken in increased doses may also be used as EC ("FDA Approves...," 1999; Rodrigues et al., 2001; Van Look & Stewart, 1998). |
Medication abortion is the use of medications that can induce abortion. There are currently two drugs available in the U.S. for this purpose — mifepristone and methotrexate. Mifepristone can be taken up to 56 days after the first day of the last menstrual period, and methotrexate can be taken up to 49 days after the first day of the last menstrual period. Both are used in conjunction with misoprostol, which is taken after either mifepristone or methotrexate to complete the abortion (Creinin & Aubény, 1999; Middleton et al., 2005; Schaff, 2000; Schaff et al., 2001). Mifepristone is more commonly used than methotrexate because it is more effective and more predictable (Grimes and Creinin, 2004; Wiebe et al., 2002). |
| How do the medications in EC work? |
How do abortifacient medications work? |
| According to the Food and Drug Administration (FDA), "Emergency contracep[tion]...act[s] by delaying or inhibiting ovulation, and/or altering tubal transport of sperm and/or ova (thereby inhibiting fertilization), and/or altering the endometrium (thereby inhibiting implantation)" (FDA, 1997). A recent study found that most often, EC reduces the risk of pregnancy by inhibiting ovulation (Marions et al., 2002). A more recent study suggests that progestin-only EC works only by preventing ovulation or fertilization, and has no effect on implantation (Croxatto et al., 2003). |
Mifepristone ends pregnancy by blocking the hormones necessary for maintaining a pregnancy. Methotrexate stops the further development of the pregnancy in the uterus. Misoprostol causes the uterus to contract and empty (Creinin & Aubény, 1999). |
| How effective is EC? |
How effective is medication abortion? |
| EC is very effective at reducing the risk of pregnancy. Studies have shown EC reduces the risk of pregnancy when taken up to 120 hours after unprotected intercourse, but the sooner the dosing begins, the more effective the treatment. When taken within 72 hours of unprotected intercourse, EC that contains both estrogen and progestin reduces the risk of pregnancy by 75 percent. Within the same time frame, progestin-only regimens, such as Plan B, reduce the risk of pregnancy by 89 percent. When initiated within 24 hours of unprotected intercourse, progestin-only EC was found to reduce the risk of pregnancy by 95 percent (Ellertson et al., 2003; Rodrigues et al., 2001; TFPMFR, 1998; Van Look & Stewart, 1998). |
Medication abortion regimens are highly effective at ending very early pregnancies. Complete abortion will occur in 9296 percent of women receiving the methotrexate regimen. Complete abortion will occur in 9697 percent of women receiving the mifepristone regimen. In the small percentage of cases in which medication abortions fail, other abortion procedures are required to end the pregnancies (ACOG, 2001; Schaff et al., 2000). |
| How safe is EC? |
How safe is medication abortion? |
| EC is safe for almost all women — millions of women around the world have used EC safely (Guillebaud, 1998; Van Look & Stewart, 1998). |
Medication abortion is safe for most women — millions of women around the world have had them safely (Creinin & Aubény, 1999). There are risks associated with all medical procedures, including abortion. In extremely rare cases, death is possible from serious complications. |
| Does EC cause an abortion? |
Can the medicines used for medication abortion also be used for emergency contraception? |
| EC will not induce an abortion in a woman who is already pregnant, nor will it affect the developing pre-embryo or embryo (Van Look & Stewart, 1998). Emergency contraception prevents pregnancy and helps prevent the need for abortion. In fact, an estimated 43 percent of the decrease in U.S. abortions between 19942000 can be attributed to the availability of emergency contraception (AGI, 2003). |
Although some studies show that mifepristone could be used in very low doses to reduce the risk of pregnancy as a method of emergency contraception within five days of unprotected intercourse, mifepristone is not approved for emegency contraceptive use in the United States at this time (Ho et al., 2002; TFPMFR, 1999). |
| Why might a woman choose EC? |
Why might a woman choose medication abortion? |
| Women may use EC as a means of preventing pregnancy after unprotected intercourse — in cases of unanticipated sexual activity, contraceptive failure, or sexual assault. Nearly half of America's 6.3 million annual pregnancies are unintended (AGI, 2004). Widespread use of emergency contraception could prevent an estimated 1.7 million unintended pregnancies and 800,000 abortions each year (Glasier & Baird, 1998; Van Look & Stewart, 1998). |
Women may choose medication abortion as a means of ending pregnancy because it is a noninvasive procedure and does not require anesthesia. It is free from the risk of injury to the cervix or uterus and the complications caused by anesthesia used in other abortion procedures (Aguillaume & Tyrer, 1995). Women who chose medication abortion also reported that they felt it was a more "natural" way to abort (Winikoff, 1995). |
| Does EC have side effects? |
Does medication abortion have side effects? |
| The most common side effects reported by women following use of EC include nausea and vomiting. Breast tenderness, fatigue, irregular bleeding, abdominal pain, headaches, and dizziness may also occur. Side effects are far less common using progestin-only EC than combination hormone EC (Van Look & Stewart, 1998). |
The most common side effects reported by women following medication abortions are similar to those of a spontaneous miscarriage — abdominal pain, bleeding, changes in body temperature, dizziness, fatigue, and gastrointestinal distress (ACOG, 2005; Creinin & Aubény, 1999; Stewart et al., 2005). |
| How long does the process of using EC take? |
How long does the process of medication abortion take? |
| EC is taken in two doses, 12 hours apart. Progestin-only EC can also be taken in one dose. Side effects associated with EC generally subside within 48 hours. EC affects the timing of the menstrual cycle in 10-15 percent of women. Changes in the menstrual cycle are seen with both combination and progestin-only EC. If the next menstrual cycle is more than one week late, a woman should visit her clinician for a pregnancy test (von Hertzen et al., 2002; Van Look & Stewart, 1998). |
It begins immediately after taking mifepristone or methotrexate. Some women may begin spotting before taking the misoprostol, the second medication. For most, the bleeding and cramping associated with medication abortion begin after taking it. More than 50 percent of women who use mifepristone abort within four five hours after taking the misoprostol. Heavy bleeding may continue for about 13 days. Spotting can last for a few weeks. About 92 percent of mifepristone abortions are completed within a week. Only 75 percent of methotrexate abortions are completed as soon — it may take up to four weeks (ACOG, 2001; el-Refaey et al., 1995; Newhall & Winikoff, 2000; Peyron et al., 1993; Wiebe et al., 2002). |
| Are women who have used EC satisfied with it? |
Are women who have had medication abortions satisfied with the method? |
| An overwhelming majority of EC users are satisfied with the method. One study found that 97 percent of EC users would recommend the method to friends and family (Harvey et al., 1999). Another study found that 92 percent of women who had used EC would use it again in the case of a contraceptive emergency (Breitbart et al., 1998). |
An overwhelming majority of women who choose medication abortion are satisfied with the method. A recent study found that 97 percent of women who had medication abortions would recommend the method to a friend. Additionally, 91 percent of the women reported that they would choose medication abortion again if they had to have another abortion (Hollander, 2000). |
| Where can I get EC? |
Where can I get a medication abortion? |
| The FDA recently approved over-the-counter (OTC) sale of Plan B to women 18 and older. It is expected to become available for OTC sale by the end of 2006 (Barr Pharmaceuticals, 2006). Plan B and other forms of EC are also available by prescription for all women. If you need a prescription for EC, contact Planned Parenthood at 1-888-743-PLAN (7526). |
Contact Planned Parenthood at 1-888-743-PLAN (7526) to find a participating clinic near you. |
| How much does EC cost? |
How much does medication abortion cost? |
| Nationwide, the price of EC ranges from $10-$35 (Hatcher et al., 2005). Costs vary from community to community, based on regional and local expenses. Contact Planned Parenthood at 1-888-743-PLAN (7526) for information about costs in your area. |
Nationwide, the price of medical abortion ranges between $350 and $575. This includes two or three office visits, testing, and exams (PPFA, 2001). Costs vary from community to community, based on regional and local expenses. Contact Planned Parenthood at 1-888-743-PLAN (7526) for information about costs in your area. |
Cited References
ACOG — American College of Obstetricians and Gynecologists. (1998, July). Statement on Contraceptive Methods.
_____. (2001, April). "Medical Management of Abortion." ACOG Practice Bulletin, 26, 1-13.
_____. (2005, October). "Medical Management of Abortion." ACOG Practice Bulletin, 67, 1-12.
AGI — Alan Guttmacher Institute. (2003, accessed 2004, November). Emergency Contraception: Improving Access. [Online]. http://www.guttmacher.org/pubs/ib_3-03.html
_____. (2004). Facts in Brief: Contraceptive Use. New York: Alan Guttmacher Institute.
Aguillaume, Claude & Louise Tyrer. (1995). "Current Status and Future Projections on Use of RU-486." Contemporary Ob/Gyn, 40(6), 23-40.
Barr Pharmaceuticals, Inc. (2006, August 24). FDA Grants OTC Status to Barr's Plan B(R) Emergency Contraceptive: Historic Dual Status Decision Provides OTC Access to Those 18 Years of Age and Older; Remains Prescription for Women 17 and Younger. [Online]. http://phx.corporate-ir.net/phoenix.zhtml?c=60908&p=irol-newsArticle&ID=899120.
Breitbart, Vicki, et al. (1998). "The Impact of Patient Experience on Practice: The Acceptability of Emergency Contraceptive Pills in Inner-City Clinics." Journal of the American Medical Women's Association, 53(5 Supplement 2), 255-8.
Creinin, Mitchell & Elizabeth Aubény. (1999). "Medical Abortion in Early Pregnancy." In Maureen Paul, et al., eds, A Clinician's Guide to Medical and Surgical Abortion. New York: Churchill Livingstone.
Croxatto, Horatio B., et al. (2003). "Mechanisms of Action of Emergency Contraception." Steroids, 68, 1095-8.
DHHS — Department of Health and Human Services. (1978). Code of Federal Regulations. 45CFR46.203.
Ellertson, Charlotte, et al. (2003). "Extending the Time Limit for Starting the Yuzpe Regimen of Emergency Contraception to 120 Hours." Obstetrics & Gynecology, 101, 1168-71.
el-Refaey, H., et al. (1995). "Induction of Abortion with Mifepristone (RU 486) and Oral or Vaginal Misoprostol." New England Journal of Medicine, 332(15), 983-7.
FDA — Food and Drug Administration. (1997). "Prescription Drug Products; Certain Combined Oral Contraceptives for Use as Postcoital Emergency Contraception." Federal Register, 62(37), 8609-12.
"FDA Approves Progestin-Only Emergency Contraception." (1999). The Contraception Report, 10(5), 8-10 & 16.
Glasier, Anna & David Baird. (1998). "The Effects of Self-Administering Emergency Contraception." The New England Journal of Medicine, 339(1), 1-4.
Grimes, David A. & Mitchell D. Creinin. (2004). "Induced Abortion: An Overview for Internists." Annals of Internal Medicine, 140(8), 620-6.
Guillebaud, John. (1998). "Commentary: Time for Emergency Contraception with Levonorgestrel Alone." The Lancet, 352(9126), 416.
Harvey, S. Marie, et al. (1999). "Women's Experience and Satisfaction with Emergency Contraception." Family Planning Perspectives, 31(5), 237-40 & 260.
Hatcher, Robert A., et al. (2005). A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation.
Ho, Pak Chung, et al. (2002). "Mifepristone: Contraceptive and Non-Contraceptive Uses." Current Opinions in Obstetrics & Gynecology, 14(3), 325-30.
Hollander, Dore. (2000). "Most Abortion Patients View Their Experience Favorably, But Medical Abortion Gets a Higher Rating than Surgical." Family Planning Perspectives, 32(5), 264.
Hughes, Edward, ed. (1972). Obstetric-Gynecologic Terminology. Philadelphia: F. A. Davis Company.
"Make the Distinction: EC Prevents Pregnancy." (2001). Contraceptive Technology Update, 22(1), 4.
Marions, Lena, et al. (2002). "Emergency Contraception with Mifepristone and Levonorgestrel: Mechanism of Action." Obstetrics and Gynecology, 100(1), 65-71.
Middleton, Tamer, et al. (2005). "Randomized Trial of Mifepristone and Buccal or Vaginal Misoprostol for Abortion Through 56 Days of Last Menstrual Period." Contraception, 72, 328-32.
Newhall, Elizabeth Pirruccello & Beverly Winikoff. (2000). "Abortion with Mifepristone and Misoprostol: Regimens,Efficacy, Acceptability and Future Directions." American Journal of Obstetrics and Gynecology, 183(2), S44-53.
Peyron, R., et al. (1993). "Early Termination of Pregnancy with Mifepristone (RU 486) and Orally Active Prostaglandin Misoprostol." New England Journal of Medicine, 328(21), 1509-13.
PPFA — Planned Parenthood Federation of America. (2002, accessed 2004, May 20). Medical Abortion — Questions and Answers. [Online]. http://www.plannedparenthood.org/ABORTION/medicalabortion.html.
Rodrigues, Isabel, et al. (2001). "Effectiveness of Emergency Contraceptive Pills Between 72 and 120 Hours After Unprotected Sexual Intercourse." American Journal of Obstetrics and Gynecology, 184(4), 531-7.
Schaff, Eric, et al. (2000). "Low-Dose Mifepristone Followed by Vaginal Misoprostol at 48 Hours for Abortion up to 63 Days." Contraception, 61(1), 41-6.
Schaff, Eric, et al. (2001). "Randomized Trial of Oral Versus Vaginal Misoprostol at One Day After Mifepristone for Early Medical Abortion." Contraception, 64, 81-5.
Stewart, Felicia H., et al. (2005). "Abortion." Pp. 673-700 in Robert A. Hatcher, et al., eds., Contraceptive Technology, 18th Revised Edition. New York: Ardent Media, Inc.
TFPMFR — Task Force on Postovulatory Methods of Fertility Regulation. (1998). "Randomised Controlled Trial of Levonorgestrel Versus the Yuzpe Regimen of Combined Oral Contraceptives for Emergency Contraception." The Lancet, 352(9126). 428-33.
_____. (1999). "Comparison of Three Single Doses of Mifepristone as Emergency Contraception: A Randomised Trial." The Lancet, 353(9154), 697-702.
Van Look, Paul & Felicia Stewart. (1998). "Emergency Contraception." In Robert A. Hatcher et al., eds, Contraception Technology, 17th Edition. New York: Ardent Media.
von Hertzen, Helena, et al. (2002). "Low Dose Mifepristone and Two Regimens of Leonorgestrel for Emergency Contraception: A WHO Multicentre Randomised Trial." The Lancet, 360, 1803-10.
Wiebe, Ellen, et al. (2002). "Comparison of Abortions Induced by Methotrexate or Mifepristone Followed by Misoprostol." Obstetrics & Gynecology, 99(5), 813-9.
Winikoff, Beverly. (1995). "Acceptability of Medical Abortion in Early Pregnancy." Family Planning Perspectives, 27(4), 142-8 & 185, 199.
Lead Author — Jennifer Johnsen
Revised by — Deborah Friedman, MPH
Published: 08.24.06 | Updated: 08.24.06
Published by the Katharine Dexter McCormick Library
©2006 Planned Parenthood® Federation of America, Inc.
All rights reserved.
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